Compression Fracture Of The Spine - Types Of Fracture, Rehabilitation And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Compression fracture of the spine

Content:

• What is a spinal compression fracture?
• Types of spinal fracture
• The consequences of a spinal fracture
• First aid for spinal fracture
• Diagnostics
• Spine fracture treatment

What is a spinal compression fracture?

A spinal compression fracture is a type of vertebral fracture. It differs from other varieties in that it is accompanied by compression of the bodies of the segments of the spine and nerve endings. This happens as follows: at the site of the fracture, the vertebra or several vertebrae are excessively compressed, as a result of which its / their height, anatomical integrity decreases. The damaged vertebrae can remain in place (in the spinal column) - this is a stable fracture. Or they are displaced - this is an unstable fracture, in which surgery is often required.

Depending on how "flattened" the vertebra is, fractures of the first - third degrees of severity are distinguished. In the first case, a part of the spine is deformed by a third, in the second - by half, and in the most severe - by more than half. The success of treatment depends on the severity of the disease. Such injuries are more likely to affect people with weakened bone tissue and those who are involved in extreme sports.

One of the symptoms of this type of fracture (like any other) is severe, piercing, sharp pain when trying to change position. This is due to a strong effect on part of the nervous system. The painful shock is so strong that the victim may become unconscious.

So, the common symptoms of spinal fractures are:

• acute pain syndrome;
• weakness or numbness of the limbs due to damage to the nerve endings up to tetraplegia - complete paralysis of the arms and legs;
• asphyxia with a fracture of the thoracic or cervical spine up to apnea - complete cessation of breathing;
• involuntary urination with a fracture of the lumbar spine.

The hallmark symptom of a compression fracture is its cause. It is provoked not by flexion / extension of the spine as a flexion-extension fracture and not by rotation of the spinal column as a rotational one, but by a strong mechanical impact.

Compression fractures differ in the presence of complications, the degree of change in the shape of the vertebra (complexity), and localization. In some cases, this pathological condition leads to disability.

A compression fracture of the spine is a very serious injury to the spinal column. It can affect anyone, regardless of age, if care is not taken during sports or an accident.

Types of spinal fracture

• fracture of the cervical spine
• fracture of the thoracic spine
• fracture of the lumbar spine
• sacrum fracture and tailbone fracture

Fracture of the cervical spine

Fracture reasons:

• osteoporosis;
• decrease in bone mass associated with age-related changes;
• Road accident - road traffic accident;
• head injuries from falling from a height, heavy objects on the head or diving.

Excessive mechanical stress on the vertebral body leads to a change in its shape to a wedge-shaped one. In a longitudinal section, the body of the damaged vertebra looks like a triangle - a wedge, therefore such a fracture is also called a simple wedge-shaped fracture. Deformity of the cervical and thoracic vertebrae is usually accompanied by difficulty breathing and swallowing.

Symptoms of a cervical spine fracture:

• acute pain in the neck, radiating to the back of the head, shoulder girdle, arms or between the shoulder blades;
• swallowing disorder;
• dizziness;
• labored breathing;
• circulatory disorder;
• noise in ears;
• the neck muscles reflexively tense.

The neck is fixed with special orthopedic collars. The most dangerous and difficult to treat are injuries to the first two vertebrae of the cervical spine. In case of a splinter fracture, hardware traction is sometimes required, the use of a Glisson loop. The traction procedure takes about a month. Each stage of traction is X-ray controlled. After its completion, the patient's neck is rigidly fixed using a plaster corset or a special Shants collar.

Most often, a neck fracture is accompanied by complications. Preventing them or at least reducing their severity is the primary task of specialists. Why are cervical vertebrae so easily damaged? The forward flexion of the head is limited to the chest, and there are no restraints during extension. Therefore, during sports, such injuries occur.

According to the classification of injuries of the cervical spine, in addition to compression, there can also be:

• fracture of the articular process;
• "mole rat" fracture - splinter fracture of the spinous processes;
• comminuted fracture of the anterior arch of the atlas;
• extensional avulsion fracture;
• fracture of the posterior arch of the atlas;
• isolated fracture of the arch;
• traumatic spondylolisthesis (displacement of the vertebrae) - "executioner" fracture;
• fracture of the odontoid process and other injuries.

Vertical compression fractures include the Jeffersonian explosive atlas fracture and multi-splinter fracture. Interestingly, the mechanisms of some types of fractures are still not well understood.

During the rehabilitation period, a rigid corset can be replaced with a more gentle cervical brace. This can be, for example, a removable soft head holder. The recovery period is quite long and requires a lot of strength and patience from the patient.

Fracture of the thoracic spine

The cause of the fracture, as in other cases, is the excess of the force of impact on the vertebra over its strength limits. Sometimes the blow is not so strong, but the bone tissue is too fragile and cannot even withstand the load during coughing. This condition is typical for the elderly.

Symptoms of a thoracic spine fracture:

• chest pain;
• muscle weakness in the back;
• numbness or paresis - incomplete paralysis of the legs;
• disorders of urination and defecation.

An urgent immobilization of the spine is required. Once the level of the fracture has been established, the severity of the fracture is determined by checking the movements, sensitivity and reflexes of the lower limbs. If the compression of the nerve roots is shallow, then mobility is likely to be limited temporarily. With strong pressure, paralysis may remain.

Diagnosing this type of fracture usually requires an X-ray of the swimmer's position with one arm raised overhead. In this position, the x-ray clearly shows the junction of the thoracic and cervical spine. But more informative is a computed tomographic study.

On an X-ray image, some tissues seem to obscure others, so-called shadowing occurs. But computed tomography also has such a disadvantage as ionizing radiation, which is harmful to health in large doses. Magnetic resonance imaging displays the spinal cord, intervertebral discs, and paravertebral tissue in detail.

The strength and duration of neurological manifestations depends on the degree of compression of the nerve elements. A decrease in the innervation of internal organs leads to a malfunction of the body as a whole. For example, intestinal obstruction may appear.

Immobilization is achieved with orthopedic aids such as corset belts, rigid posture correctors with a backrest, and tissue reclinators for shoulder abduction. During the protective period, physical activity is prohibited, including weight lifting.

Prolonged and strict bed rest leads to complications from the circulatory, respiratory and excretory systems. Compression garments and breathing exercises help prevent this. With proper treatment, a thoracic spinal fracture can be completely healed.

Fracture of the lumbar spine

This type of fracture is more common in older people. Their fragile bone tissue is easily destroyed. There are 5 vertebrae in the lumbar spine. The load on them is very high. Bone tissue can "wear out" due to calcium deficiency. Inadequate nutrition, metabolic disorders contribute to the occurrence of fractures. The destruction of bone tissue can be a consequence of such pathologies as tuberculosis and syphilis.

Lumbar spine fracture symptoms:

• back or buttock pain;
• loss of consciousness;
• forced position of the body;
• development of terminal conditions;
• asphyxia;
• muscle weakness;
• intermittent claudication;
• defecation and urination disorders.

The pain syndrome with a lumbar fracture weakens in the supine position. Diagnosis requires checking the sensitivity of the perineum and anal reflex. A spinal injury is an injury to the “spinal cord” that interferes with the functioning of the spinal cord. If a complete anatomical rupture occurs, then paralysis of the legs is inevitable. There are also fatigue fractures of the lumbar vertebrae, for example, in professional athletes.

If there is no significant displacement of the vertebrae, then it is enough for the patient to unload the spine with the help of a thoracolumbar-sacral orthosis or a lumbosacral corset. These retainers cannot be permanently removed over several months. In order to timely identify the appearance of instability of the vertebrae, an X-ray examination is periodically performed.

In order to avoid or minimize the residual symptoms of a lumbar spine fracture, it is enough to follow the recommendations of doctors and work hard to prevent the disease.

Sacrum fracture and tailbone fracture

The sacrum and coccyx are so closely related that the prerequisites, symptoms and treatment for their fracture are almost identical. The tailbone is the "tail" of the spine of accrete rudimentary vertebrae. This is an important fulcrum. Coccyx fractures are a relatively rare pathology precisely due to its inactivity. A little more often, fractures occur at the junction of the sacrum and coccyx. They may be accompanied by displacement of the vertebrae - fracture dislocation.

Causes of sacrum or tailbone fractures:

• car crashes;
• prolonged shaking driving;
• sports injuries;
• falling on the buttocks from a great height;
• age-related fragility of bones;
• obstetric process.

The main symptom of a sacrum or coccyx fracture is acute, radiating pain in the lower back or buttocks to the legs, aggravated by bowel movements, intercourse, change in body position and walking. Fatigue fractures of the sacrum occur in runners. To diagnose it, two tests are carried out: balance and jumping on one leg.

Prehospital stage, i.e. transportation of the patient must be carried out correctly. Sometimes, on the way to the hospital, due to inept transferring to the stretcher or turning the body, complications appear that could well have been avoided. Transfer to a hard "shield" surface should be three. Bed rest will help the bones to heal calmly, and a special rubber circle or roller will reduce bedsores and pain.

Treatment of sacral and coccyx fractures - limiting physical activity and relieving the spine. The patient is forbidden to sit for a long time. The process of bone fusion is X-ray controlled. In case of their erroneous attachment, an operation is performed. Improper fusion of the lower segments of the spine causes persistent dysfunction of the pelvic organs.

The consequences of a spinal fracture

The consequences of a spinal fracture can be:

• segmental spinal instability;
• neurological diseases, the type of which depends on which nerve endings are squeezed;
• injury to nerve structures;
• radiculitis - pathology of the nerve roots of the spinal cord;
• chronic pain syndrome;
• the impossibility of the act of breathing, requiring constant artificial ventilation of the lungs;
• spondylosis with the formation of osteophytes - spine-like bone growths along the edge of the vertebrae;
• the formation of pointed kyphosis (hump) - anteroposterior curvature of the spine;
• bone callus;
• scoliosis - lateral curvature of the spinal column;
• joint stiffness;
• paresis or paralysis of the limbs;
• spinal protrusion - protrusion of the intervertebral discs without rupture of the fibrous rings;
• disc hernia;
• spinal fluid outflow;
• thrombosis and congestive pneumonia due to prolonged immobility;
• bleeding;
• infection;
• suppuration;
• cyst;
• fistula;
• non-closure of the vertebra.

The severity of the consequences is determined by the severity of the disease and the literacy of the treatment. Unprofessional intervention can irreversibly aggravate the situation.

First aid for spinal fracture

First aid rules are important, first of all, because without knowing them, you can permanently deprive the victim of the ability to move independently. The position of the body during the transportation of the patient is of incredible importance here! Only the correctness and thoughtfulness of the actions of the "rescuers" leaves a chance for recovery.

The injured person is transported only on a hard surface. If possible, analgesics are administered orally or intramuscularly. The injured area of the body must be secured before transportation. It is rather difficult to do this without special means, so it is better to immobilize the entire spinal column. Any sufficiently large, rigid surface from a wide board to a table top works well for this. It is best to tie the victim to it.

It is advisable to fix his neck as well to restrict head movements. This measure will help prevent additional damage to the vertebrae. The patient is shifted by three of them in one smooth synchronous movement.

You can't

• to plant a person;
• put him on his feet;
• try to straighten the vertebrae yourself;
• pull the legs or arms;
• give oral medications if swallowing is impaired or the patient is unconscious.

Knowledge of the course of first aid can be useful in life for anyone. Ideally, everyone should master the basic necessary knowledge and a set of emergency medical measures.

Diagnostics

To begin with, the doctor confines himself to an external examination, palpates the spine. The damaged area is found in that part of the spine, when touched, the patient experiences particularly severe pain. In the case of fragments, fragments can also be identified by touch.

To confirm the preliminary diagnosis, an x-ray is usually prescribed and sent to a neurologist to check the functions of the spinal cord and the work of nerve endings. X-ray quite well reveals pathologies of bone tissue and tumors that could cause a fracture. Desirable radiography in frontal, lateral and oblique (intermediate) projections. But, for example, the upper cervical vertebrae can be "photographed" only through the open mouth in the supine position. A functional radiograph is very informative. It is done in the position of maximum flexion and extension of the spinal column.

When interpreting an X-ray, an orthopedist carefully evaluates the shape, size and position of the vertebrae. For the accuracy of the diagnosis, special techniques have been developed to facilitate the assessment of X-ray results. The vertebral bodies are connected by a contour. This allows you to more clearly see the deviations, deformation of the lines of the spinal column.

In the process of bone fusion, control X-ray examinations are regularly carried out. This is a necessary measure. It allows you to prevent improper bone fusion in time, for example, the formation of a hump. Myelography - a type of X-ray examination - allows you to assess the condition of the spinal cord.

So, diagnostic procedures for a spinal fracture:

• radiography;
• CT - computed tomography;
• MRI - magnetic resonance imaging;
• SPECT - single-photon emission CT;
• radionuclide bone scanning;
• bone densitometry - assessment of bone density;
• research for hyperparathyroidism, one of the endocrine disorders;
• General blood analysis;
• serum protein electrophoresis;
• ESR - erythrocyte sedimentation rate;
• determination of the level of PSA - prostate-specific antigen - and the level of antinuclear antibodies;
• vaginal and rectal (digital examination of the rectum) examinations to detect bone fragments;
• ECG - electrocardiography to study the work of the heart in fractures of the thoracic spine.

CT or MRI even allow a more detailed study of the features of the damage. Densitometry in doubtful cases excludes osteoporosis. The stronger the bones, the less likely a fracture will occur.

After the diagnosis of a "fracture" is made and the precise determination of its location, the attending physician determines the type of pathology:

• flexion - only the anterior part of the vertebral body is "flattened";
• axial - the height of both the front and back of the vertebra decreases;
• extension;
• rotational - the anatomical integrity of the transverse processes of the vertebrae is disrupted.

You need to know this to develop a treatment method. The list of the listed diagnostic procedures is quite impressive, but usually an X-ray is sufficient. Additional measures are prescribed to exclude other diseases.

Spine fracture treatment

The success of the therapeutic course depends on many factors: the severity of the pathology, the amount of damage to the internal organs, the professionalism of the doctors and even the patient's willpower. In severe cases, surgery is required.

Conservative treatment is usually sufficient in uncomplicated cases when the fracture site is stable and the height of the vertebrae changes slightly. Hospitalization usually lasts from one to several months.

The therapeutic course includes:

• a course of anesthetics, as well as electrical stimulation, cryotherapy - cold treatment - or massage to get rid of pain;
• antibiotic therapy for infection;
• fortifying, immunostimulating agents;
• vitamins;
• calcium preparations;
• bed rest using orthopedic mattresses;
• rectification enemas for tailbone fractures;
• hardware traction, the use of a Glisson loop;
• physiotherapy exercises at the final stage of treatment;
• hirudotherapy;
• physiotherapy - magnet, phonophoresis, muscle electrical stimulation - about a month and a half after injury.

Treatment begins with rest. For some time, the patient should remain as still as possible. This is the only way for the spine to recover. Bed rest for older people should be observed longer than for young people. At their age, bone tissue grows together much more slowly.

Sometimes, despite nonsurgical treatment, symptoms of the disease persist. This indicates an incorrect diagnosis, an error in determining the type of fracture. Then the patient undergoes additional examination.

The operation is necessary in case of a fracture of the second or third degree of severity, instability (displacement) and acute pain that cannot be stopped. In a comminuted fracture, a laminectomy is performed to decompress (“release”) the spinal cord and nerve roots. It occurs as follows: the spinal arches are opened and fragments are removed from the spinal canal. This way it is possible to achieve stabilization of the vertebrae and intervertebral discs.

Fracture of the sacrum may require spinal fusion, an operation performed in order to completely immobilize a part of the spine using special metal structures. Plastic surgery is necessary when the vertebra is so damaged that it needs to be replaced with a graft made of synthetic polymers.

During surgical intervention, the following metal structures can be implanted to prevent bone displacement:

• transarticular fixators;
• laminar;
• special plates.

In each case, the treatment tactics are determined individually. Even with successful treatment, the body needs a rehabilitation course for six months. In addition to the complex of physiotherapy exercises, the attending physician recommends swimming lessons with an instructor. Sometimes a course of neurological therapy and acupuncture is also recommended.

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Exercise therapy for compression fracture of the spine

Remedial gymnastics is absolutely essential. For bone fusion, a part of the body is temporarily immobilized. For a month or more, the adjacent muscles practically atrophy. The recovery period for the patient is as difficult as the treatment itself. Physical activity is selected strictly individually. The golden rule of exercise therapy is adherence to the sequence of physical activity.

When performing exercises of a rehabilitation physical therapy complex, it is important how strong the patient's self-discipline is. Physical activity can be quite painful at first. It is recommended to master the set of special exercises under the supervision of an instructor. Closer to the end of the recovery period and, if possible, you can practice at home.

Functions of exercise therapy for compression fracture of the spine:

• strengthening the back muscles that support the spinal column;
• improving the flexibility of the spine;
• posture straightening;
• improved coordination of movements.

The key to the success of exercise therapy is the exact observance of all the prescriptions of the doctor and instructor, as well as a gradual, rather than rapid return to previous activity. People after a spinal fracture should continue to exercise regularly for preventive purposes.

For bedridden patients, breathing exercises are of great importance. Thanks to exercise therapy, the victim fully restores physical performance in a fairly short time.

Corset for compression fracture of the spine

The corset additionally fixes the spinal column. It reduces the stress on the vertebrae, which prevents instability. Its positive effect does not appear immediately. Usually, the plaster cast is removed after about 4 months. The application of a corset is mandatory for a compression fracture of the cervical spine.

Orthopedic corsets differ not only in the shape and method of attachment, but also in the degree of fixation. They can have a different number of stiffeners.

Thus, there are 3 types of corsets applied for fractures:

• tough;
• semi-rigid;
• soft.

Corset belt is otherwise called lumbosacral corset or lumbar brace. It may or may not be warming, with or without clasps. The range of their application is quite wide. So, some women use such corsets for weight loss.

As the motor regime expands, the dressings become looser. In this regard, it is much more practical to purchase corsets with several degrees of fixation, easily adjustable.

Spinal fracture massage

Massage may be prescribed by your doctor to relieve pain and muscle spasms. During the recovery period, this procedure is important for strengthening the muscle "corset" of the spine.

The method of the massage session depends on the type of fracture and the duration of the rehabilitation course. Complete restoration of the spine is possible thanks to the use of several of its varieties: classical, reflex and point.

Compression fracture of the spine is a very serious injury. Any damage to the "axis", "core" of our body for a long time or permanently restricts mobility. But there are types of fractures that are much more difficult to treat, so one should not despair and give up. There are cases when people with such a diagnosis were quickly and completely cured, even despite the gloomy forecasts of doctors.

Author of the article: Kaplan Alexander Sergeevich | Orthopedist

Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.